Impact of liver fibrosis score on prognosis after common therapies for intrahepatic cholangiocarcinoma: a propensity score matching analysis

Abstract

Background: Liver fibrosis or cirrhosis is associated with the dismal prognosis of hepatocellular carcinoma (HCC), and it might also be involved in intrahepatic cholangiocarcinoma (ICC). The effect of hepatic fibrosis on the survival of ICC patients is still unclear. This study aims to explore whether liver fibrosis impacts the overall survival (OS) and disease-specific survival (DSS) of ICC patients. Methods: Data of 729 eligible ICC patients receiving different therapies from the Surveillance, Epidemiology, and End Results database (2004-2015) were analyzed. Unmatched, propensity score-matched, and propensity scoreweighted cohorts were used to investigate the relationships of different fibrosis scores (low fibrosis score vs. high fibrosis score) and survival. A Cox regression and Kaplan-Meier curves were used to explore the influence of fibrosis score on patients' survival. Stratified analyses based on treatment modality were conducted to compare the survival difference in ICC patients with different fibrosis scores. Results: Before matching, the one-, three-, and five-year OS were 50.9, 28.0, and 16.1% in the low fibrosis score group (n = 465) and 39.3, 20.1, and 8.0% in the high fibrosis score group (n = 264) (P < 0.001), respectively. After propensity score matching, the one-, three-, and five-year OS were 45.0, 26.0, and 10.2% in the low fibrosis score group and 36.0, 8.1, and 2.3% in the high fibrosis score group (P = 0.008), respectively. The multivariate Cox regression results showed that a high fibrosis score was an independent risk factor of OS. Additionally, patients with high fibrosis scores achieved low DSS after matching (P = 0.032). The survival benefits of the low fibrosis score group were consistent across treatment cohorts. Conclusions: High fibrosis scores were associated with poor clinical outcomes of ICC patients receiving different common therapies.

Impact of Liver Fibrosis on Survival of Patients with Intrahepatic Cholangiocarcinoma Receiving Gemcitabine-Based Chemotherapy

“…In the case of cirrhosis, rates were significantly diminished for OS but not for PFS. A plethora of studies analyzed the impact of liver fibrosis or cirrhosis on the survival of patients after surgical resection of an iCCA [ 15 , 16 , 17 , 23 ]. For example, a study by Li et al could identify cirrhosis as an unfavorable prognostic factor in surgically treated iCCA [ 18 ].…”

“…Recently, two SEER (Surveillance, Epidemiology, and End Results)-based analyses investigated the impact of fibrosis in large cohorts on survival after surgery and non-surgical therapies. Thereby, Zhang et al demonstrated that high fibrosis scores were associated with poor clinical outcomes [ 15 ]. Correspondingly, Levy et al showed that advanced liver fibrosis has an increased risk of both overall and cancer-specific mortality [ 17 ].…”

“…Merely a few prognostic factors have been investigated in recent years, including tumor size, surgery, pathological grade or Union for International Cancer Control (UICC) stage [ 14 ]. The role of liver fibrosis as a prognostic marker for survival is still controversially discussed [ 15 , 16 , 17 , 18 ]. Moreover, data of the potential influence of fibrosis on the outcome of patients receiving chemotherapy are currently missing.…”

NF-κB–Dependent Snail Expression Promotes Epithelial–Mesenchymal Transition in Mastitis

“…However, inflammation, type II EMT and type III EMT are usually correlated to a certain extent, and type II EMT can induce and enhance type III EMT [ 41 , 42 ]. Therefore, fibrotic diseases are mostly associated with the poor prognosis of tumors [ 43 , 44 ]. In this study, Snail was expressed in the parenchyma but not in the mesenchyme, indicating that a partial EMT occurred in epithelial cells.…”

Effect of liver fibrosis on survival in patients with intrahepatic cholangiocarcinoma: a SEER population-based study

“…In our study we were able to establish the association between advanced fibrosis and survival by utilizing the largest cohort to-date, including 512 patients, 192 (37.5%) of whom with advanced fibrosis, and by stratifying the cohort according to both stage and surgical treatment while characterizing how the association differs between groups. Recently, Zhang et al [ 19 ] analyzed an iCCA cohort derived from the SEER database and found that advanced fibrosis was associated with worse overall and cancer specific survival, and worse overall survival in patients following surgery but not for patients that did not undergo surgery. In their study, no stratification according to tumor stage was performed and a multivariable analysis was used only for overall survival assessment on the entire cohort and not for cancer-specific survival or any of the sub-groups.…”